Mary McMurran

Motivational interviewing with offenders: A systematic review

Purpose. Offender motivation is one specific responsivity variable in offender treatment and motivational interviewing (MI) is commonly used by corrections personnel. Although evidence for the effectiveness of motivational interviewing is accruing overall, a review of MI specifically with offender populations is required. Method. Relevant databases and websites were searched using terms relating to MI with offenders. Results. In total, 13 published studies and 6 dissertation abstracts were identified. MI is most evaluated in relation to substance misusing offenders (N=10). Other applications are with domestic violence offenders (N=3), drink-drivers (N=5), and general offending (N=1). In these populations, MI is used to enhance retention and engagement in treatment, improve motivation for change, and change behaviour. Conclusions. MI can lead to improved retention in treatment, enhanced motivation to change, and reduced offending, although there are variations across studies. To advance the study of MI with offenders, a theory of change needs to be articulated on which testable hypotheses may be based. The integrity of treatment in its application needs to be assured. Based on these foundations, more outcome research is needed to examine who responds to what type of MI in relation to treatment retention, readiness to change, and reconviction.

Is treatment non-completion associated with increased reconviction over no treatment?

Abstract There is accruing evidence that offenders who do not complete treatment are at greater risk of recidivism than those who do complete treatment. Profiles of non-completers show them to be high risk of reoffending compared with completers, and differences in reconviction may be explained by these baseline levels. What is unclear is whether non-completion actually increases the risk of reoffending over no treatment at all. The purpose of this review was to examine the recidivism of non-completers compared with untreated offenders of comparable risk. A systematic search of the literature relating to cognitive–behavioural interventions revealed 16 relevant studies describing 17 samples. The mean effect size (d=−0.16) of differences in reoffending between untreated offenders and treatment non-completers suggests that failing to complete treatment is associated with elevated levels of reoffending, with this effect being more pronounced in community samples (d=−0.23) than institutional samples (d=−0.15). Methodological limitations include poor risk comparability between samples and heterogeneity of non-completers, nevertheless it is possible that treatment non-completion may make some offenders more likely to reoffend.

Non-completion of personality disorder treatments: a systematic review of correlates, consequences, and interventions.

Non-completion of treatment is a major concern in the provision of therapies for people diagnosed with personality disorder, with adverse consequences for services, therapists, and other patients. Of even greater concern is that non-completion of treatment may limit the effectiveness of therapy for individuals. Our main aim in this study was to conduct a systematic review of the literature on psychosocial treatments for personality disorder to identify factors associated with treatment non-completion. Two subsidiary aims were to identify studies that reported the relative outcomes of treatment completion and non-completion, and to identify studies that evaluated psychosocial interventions specifically aimed at improving retention in treatment. This information is potentially useful in informing selection criteria and directing efforts towards improving treatment engagement. Twenty-five empirical studies of factors predicting treatment non-completion were identified. The median non-completion rate was 37%. A range of patient characteristics, need factors, and environment factors were identified as associated with non-completion. However, the studies could not be considered homogeneous group for meta-analysis. Four studies investigated the effects of treatment non-completion, showing an association with adverse outcomes. Only two studies of interventions specifically aimed at reducing non-completion were identified. Implications for clinical practice and research are discussed.

Forensic Case Formulation

Formulation is the process or product of gathering and integrating diverse information to develop a concise account of the nature and etiology of the problems affecting a persons mental health to guide idiographic treatment design and other decision-making. Formulation is a core competency in mental health practice, including forensic mental health; however, there is no agreement concerning the details of how it should be done or how to evaluate it, either generally or more specifically with respect to forensic mental health. The purpose of this paper is to raise specific issues in the practice and evaluation of forensic case formulation, and so enhance the profile of this important area of work. In this paper, we (1) define case formulation and describe its key features, (2) specify criteria for evaluating case formulation, and (3) address challenges in forensic practice, with suggestions for advancing practice through research. We conclude with a proposed research agenda that we hope will encourage and promote activity in this important area.

Increasing Recognition of Happiness in Ambiguous Facial Expressions Reduces Anger and Aggressive Behavior

The ability to identify emotion in other people is critical to social functioning. In a series of experiments, we explored the relationship between recognition of emotion in ambiguous facial expressions and aggressive thoughts and behavior, both in healthy adults and in adolescent youth at high risk of criminal offending and delinquency. We show that it is possible to experimentally modify biases in emotion recognition to encourage the perception of happiness over anger in ambiguous expressions. This change in perception results in a decrease in self-reported anger and aggression in healthy adults and high-risk youth, respectively, and also in independently rated aggressive behavior in high-risk youth. We obtained similar effects on mood using two different techniques to modify biases in emotion perception (feedback-based training and visual adaptation). These studies provide strong evidence that emotion processing plays a causal role in anger and the maintenance of aggressive behavior.

Why don't offenders complete treatment? Prisoners’ reasons for non-completion of a cognitive skills programme

Abstract In an evaluation of the Enhanced Thinking Skills (ETS; Cann et al., 2003) programme, reconviction at 1 year was higher for treatment non-completers (i.e. those allocated to treatment who started but did not complete) than for untreated prisoners (i.e. those not allocated to treatment). It may be that non-completion increases risk of reconviction for some offenders, hence efforts should be made to reduce non-completion rates. In designing retention strategies, the views of offenders are important. This study, conducted with adult male prisoners, elicited information from ETS non-completers (n=18) about what interfered with programme completion. For comparison, views on ETS of completers (n=6) were taken. The main themes were: (1) non-completers were motivated to stop offending and motivated for treatment; (2) compared with completers, non-completers saw ETS as less relevant and less well-timed in relation to their current concerns; (3) some non-completers found ETS too demanding, while others found ETS too slow and patronizing; and (4) working in a group was an area of dissatisfaction for non-completers. Limitations are the small sample size, varying reasons for non-completion, and gathering of offenders’ views retrospectively. In future, treatment engagement should be studied prospectively, examining different categories of non-completers, and using larger samples.

Anger control and alcohol use: Appropriate interventions for perpetrators of domestic violence?

Abstract This paper addresses the differences between cultural/feminist and psychological perspectives on domestic violence, with specific reference to the roles of anger and alcohol. Feminist perspectives assume patriarchal control to be at the root of domestic violence, and see anger and alcohol as excuses for abusive behaviour. Psychological approaches identify anger and alcohol as risk factors for violence in some subgroups of offenders. A risk–needs model is presented, in which a distinction is drawn between acute and stable dynamic risk factors. Both may be targets of intervention, but addressing stable dynamic risk factors is more likely to effect enduring change. A theoretical understanding is required to identify stable dynamic risk factors, and here we suggest an affective defence approach to anger-related domestic violence and a social problem solving approach to alcohol-related domestic violence. Further developments in risk assessment and treatment matching are recommended.

Alcohol and violence

Research indicates a strong relationship between drinking and violent crime. Aggression and heavy drinking may be associated in the same people, therefore it is instructive to see how the development of violence interacts with the development of drinking across the lifespan. A developmental pathway is traced across the lifespan, indicating how certain individual characteristics independently increase the likelihood of both drinking and violence, and how the ways certain individuals interact with their social environment increase the likelihood of both drinking and violence. Attention is paid to the pharmacological and cognitive effects of alcohol in relation to aggressive behaviour. In tracing a developmental pathway, the risk factors for alcohol-related violence are identified, indicating appropriate targets for prevention and intervention. Since generally violent men form one subgroup of perpetrators of domestic violence, this subgroup being more severely violent and characterized by being themselves abused as children, having witnessed parental violence and having high rates of substance use, and because witnessing or experiencing violence breeds the next generation of perpetrators of domestic violence, it is important to break the cycle by recognizing and changing violent individuals, as well as preventing further damage to their offspring. Copyright

Measuring motivation to change in offenders

Abstract Measuring motivation to change in offender populations is important both for selection into treatment programmes and for assessing progress in therapy. Two studies are reported in this paper, both looking at the psychometric properties of questionnaires designed to measure stage of change in therapy. The samples used were patients detained in special hospitals under the Mental Health Act (1983) classification of psychopathic disorder. The first study provides norms for this group on the stages of change in psychotherapy questionnaire, plus some additional information on its relationship with self-esteem and self-efficacy measures. The second study looked at a brief version of the stages of change questionnaire, concluding that its psychometric properties were such that further use was contra-indicated.

The relationship between social problem-solving and personality in mentally disordered offenders

Poor social problem-solving skills may account for some criminal behaviours in mentally disordered offenders, and social problem-solving may be mediated by personality traits. We examined the relationship between personality and social problem-solving in 52 mentally disordered offenders, (38 mentally ill and 14 personality disordered) detained in a regional secure unit. Since t-tests indicated no differences between the mentally ill and personality disordered groups, they were pooled into a single sample. Correlations indicated that high neuroticism (N) was related to poor social problem-solving, and high scores on the other five-factor traits were related to good social problem-solving. High N, which is a core feature of personality disorders as well as being a common feature of offenders, may signal emotional reactivity which militates against effective social problem-solving. N is, however, negatively correlated with extraversion (E), conscientiousness (C), and agreeableness (A), therefore partial correlations were conducted controlling for N. Once N is discounted, the main trait associated with problem-solving is openness (O), which is positively related to problem-solving, perhaps due to the relationship of O to intelligence and creativity. A positive correlation between E and a more positive problem orientation remains, perhaps because optimism is a defining feature of high E.